Diaphragmatic hernia can occur through all the following, EXCEPT:

Diaphragmatic hernia can occur through all the following, EXCEPT:

A. Oesophageal opening
B. Costovertebral triangle
C. Costal and sternal attachment of the diaphragm
D. Inferior vena caval opening

Answer is D. Inferior vena caval opening

Inferior vena caval opening is situated at about 8th thoracic vertebra, transmits the vena cava and is not a site for diaphragmatic herniation.

Possible sites of diaphragmatic hernia are:

1. Oesophageal hiatus: Site of hiatus hernia, comprising 98% of all diaphragmatic hernias.
2. Sternocostal triangle: Lies between sternal and costal areas and transmits superior epigastric vessels and is a potential site for acquired herniation.
3. Lumbosacral triangle: Situated between costal and lumbar vertebral portions (costovertebral). Stomach and other peritoneal viscera herniate through it.

A quick review of the various openings of the diaphragm: